Keywords
Breast Reconstruction
ADM
Covid-19
Diep Flap
How to Cite
Abstract
Implant infection after breast reconstruction is always disastrous and often leads to the need to remove the prosthesis and delayed reconstruction. In those cases when conservative treatments fail (i.e., oral or i.v. antibiotics), a surgical approach is necessary. Removing the implant and debridement are always required, but which are the following reconstructive steps? In the literature, different solutions chosen based on the severity of the infection are described. In the pandemic Covid-19 era, the healthcare system has to deal with a significant restriction in the delivery of surgical services due to the recruitment of hospital staff members to the “Covid-19 frontline”. Although implant removal for infection represents an urgent deferred procedure, the reconstruction is not considered as such. Here we report on a case of breast reconstruction with Deep Inferior Epigastric Perforator (DIEP) flap in a patient having a severe implant infection during the Italian second wave of the pandemic (February- March 2021). Initially, she was locally treated with the removal of the implant and the simultaneous application of negative wound pressure therapy with irrigation in the pocket site, which led us to an “immediate” reconstruction (10 days after implant removal) with a DIEP flap.
References
Specht M, Sobti N, Rosado N, Tomczyk E, Abbate O, Ellis D, et al. High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis. Breast Cancer Res Treat. 2020;182(3):679–88. https://doi.org/10.1007/s10549-020-05739-7
Knackstedt R, Scomacao I, Djohan R. Utilization of irrigating negative pressure wound therapy for breast implant salvage: Long-term results and success. J Plast Reconstr Aesthet Surg. 2020;74(2):407–47. https://doi.org/10.1016/j.bjps.2020.08.058
Spear SL, Seruya M. Management of the Infected or Exposed Breast Prosthesis: A Single Surgeonʼs 15-Year Experience with 69 Patients. Plast Reconstr Surg. 2010;125(4):1074–84. https://doi.org/10.1097/prs.0b013e3181d17fff
Meybodi F, Sedaghat N, French J, Keighley C, Mitchell D, Elder E. Implant salvage in breast reconstruction with severe peri-prosthetic infection. ANZ J Surg. 2015;87(12):E293–9. https://doi.org/10.1111/ans.13379
Meybodi F, Sedaghat N, Elder E, French J, Adams K, Hsu J, et al. Salvaging the Unsalvageable: Negative Pressure Wound Therapy for Severe Infection of Prosthetic Breast Reconstruction. Plast Reconstr Surg- Global Open. 2021;9(3):e3456. https://doi.org/10.1097/gox.0000000000003456
Constantine T. Use of Negative-Pressure Wound Therapy With Instillation and Dwell in Breast Reconstruction. Plast Reconstr Surg. 2020;147(1S-1):34S42S. https://doi.org/10.1097/prs.0000000000007612
Cheong JY, Goltsman D, Warrier S. A New Method of Salvaging Breast Reconstruction After Breast Implant Using Negative Pressure Wound Therapy and Instillation. Aesthetic Plast Surg. 2016;40(5):745–8. https://doi.org/10.1007/s00266-016-0668-z
Brinkert D, Ali M, Naud M, Maire N, Trial C, Téot L. Negative pressure wound therapy with saline instillation: 131 patient case series. Int Wound J. 2013;10(s1):56–60. https://doi.org/10.1111/iwj.12176
Chicco M, Huang TC-T, Cheng H-T. Negative-Pressure Wound Therapy in the Prevention and Management of Complications From Prosthetic Breast Reconstruction. Ann Plast Surg. 2021;87(4):478–83. https://doi.org/10.1097/sap.0000000000002722
Haque S, Kanapathy M, Bollen E, Mosahebi A, Younis I. Patient-reported outcome and cost implication of acute salvage of infected implant-based breast reconstruction with negative pressure wound therapy with Instillation (NPWTi) compared to standard care. J Plast Reconstr Aesthet Surg. 2021;74(12):3300–6. https://doi.org/10.1016/j.bjps.2021.05.014
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